Form USPTO/550 Patent Pro Bono Survey

USPTO/550 OMB Control Number: 0651-0082

Expiration Date XX/XX/XXXX

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Draft Quarterly Metrics Reporting Questionnaire

Name of Person Reporting Metrics

Email of Person Reporting Metrics

1. What is the name of your regional pro bono program?

2. Reporting Year

3. Reporting Quarter

4. Number of inventor inquiries into your program this quarter?

5. Number of applicants that applied to your program this quarter (applicants that submit a client intake form/application)?

6. Breakdown of applicants applying from each U.S. State [e.g., CA = 35; NV = 6; HI = 2]

7. List any additional referral sources (other than National Clearinghouse and direct application to your program)

8. Number of applicants approved for placement?

9. Number of applicants placed with an attorney/agent this quarter?

10. Cumulative Backlog [total number of applicants approved for placement but not matched with an attorney/agent for legal services as of the end of this quarter]

11. Total number of practitioners agreeing to accept cases as of the last day of this quarter?

12. Estimated number of hours donated by lawyer referral service panel practitioners serving in your program this quarter?

13. Number of provisional patents filed through the program this quarter?

14. Number of non-provisional patents filed through the Program this quarter?

15. Number of design patents filed through the Program this quarter?

16. List the patent numbers for the patents that issued this quarter [Patent No are formatted X,XXX,XXX. DO NOT LIST patent application numbers which are formatted XX/XXX,XX

A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995, unless the information collection has a valid OMB Control Number. The OMB Control Number for this information collection is 0651-0082. Public burden for this questionnaire is estimated to average 1.75 hours (105 minutes) per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the Office of the Chief Administrative Officer, United States Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450 or email [email protected].